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Payment Procedure of Cashless Medical Treatment (Indoor)

Government of West Bengal
Finance Department
Nabanna, Howrah

No. 5069-F(MED) Dated: 26-09-2014

NOTIFICATION

The Government of West Bengal has recently notified West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme, 2014 vide notification no. 4476-F(MED) dtd. 28.8.2014 read with Notification No. 4656-F(MED) dated 05-09-2014 wherein detail procedures, including mode of payment, have been laid down regarding cashless medical treatment facility upto a ceiling of Rupees one lakh to the eligible beneficiaries in private empanelled hospitals within the State and the National Capital Region, Delhi.

2. Since then some suggestions have been received from various quarters including District Magistrates and HCOs requesting some changes in payment procedure and upon a comprehensive review of the scheme in the light of the suggestions received, the Governor, in partial modification of Notification No. 4656-F(MED) dated 05-09-2014, read with memorandum No. 4803-F(MED) dated: 12-09-2014, is now pleased to order that, henceforth, following payment procedure may be followed for payment of cost of admissible claim of treatment and medical attendance to the empanelled private Health Care Organisations (HCO) for providing indoor medical treatment as per the scheme .

3. In case of HCOs in Kolkata, the receipted bill along with copies of all prescriptions, reports, bills etc as are ordinarily required to be given by the hospital authority to the patient party for seeking reimbursement in terms of the provisions of WBHS 2008, will now be required to be sent to the respective Government department of the employee/ pensioner as per his declaration. The name of the ‘department’ in which the employee is posted immediately prior to his seeking treatment for self or his eligible family member in a HCO will be treated as the ‘department’ for this purpose. In case of employees of government offices located in regional offices in the districts and National Capital Region, Delhi, who may seek medical treatment in a HCO located within Kolkata region, the department which administratively controls the office of the employee will be treated as the ‘department’ for this purpose. The concerned department, after due scrutiny of the bills, will authorize payment to be made to the concerned HCO for the cashless part of the treatment rendered through online procedure to the Medical Cell of the Finance Department. In case of pensioners/family pensioners, the name of the ‘department’ will be the administrative department which controls the PSA. The department will send online approved payment advice with digital signature of the competent authority to the Medical Cell of Finance Department for making payment to the HCOs on a monthly basis through bank transfer to the authorized bank account of the HCO.

4. In respect of the HCOs of a particular district, the receipted bill along with copies of all prescriptions, reports, bills etc as are ordinarily required to be given by the hospital authority to the patient party for seeking reimbursement in terms of the WBHS 2008, will be required to be sent to the District Office of the beneficiary for scrutiny and payment. The concerned district office, after due scrutiny of the bills, will authorize payment to be made to the concerned HCO for the cashless part of the treatment rendered through online procedure to the District Magistrate of the concerned district. The district office will send online approved payment advice with digital signature of the competent authority to the District Magistrate for payment to the HCOs. The Medical Cell of the District Magistrate will release payment to the HCOs on a monthly basis through bank transfer to the authorized bank account of the HCO.

5. All the payments will be made within one month of receipt of the claims from the HCOs. Payment will be made by bank transfer to the nominated bank account of the HCO after deducting applicable taxes once in a month. An abstract statement of the payment released will be sent by email to the HCO by concerned Department / District Office.

6. In respect of HCOs located in the NCR, New Delhi, the procedure relating to a department mentioned above will be followed mutatis mutandis by the Resident Commissioner, New Delhi. Payment will also be made from the end of the Resident Commissioner, New Delhi following the procedure meant for Finance Department as provided in para 3 above.

7. In case of the beneficiaries whose indoor treatment cost is more than Rupees One lakh, the treatment cost up to Rupees One lakh will be covered under the said scheme. The balance amount over and above the ceiling of Rupees One lakh will have to be paid by the beneficiary concerned to the HCO at first. Then the eligible Govt. Employee/Govt. Pensioner would submit his/her medical reimbursement claim along with photo copies of vouchers/cash-memos for balance amount to the respective Head of Office as per provision of WBHS, 2008. However, HCOs have to seek necessary permission for treatment with the cost exceeding Rs. 2.5 Lac and performing some specific procedures as per Finance (Audit ) Deptt, Medical Cell Memo No. 796-F(Med ) dt 31.01.2011 (Clause-8,9,15), Memo No. 797-F(Med ) dt 31.01.2011 (Clause-14), Agreement with HCO (Clause 8.16, 8.17, 8.18) and No. 71(80)-F(Med)-WB Dt 09.10.2013.